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Medical Billing17-31
Insurance Terms 17-31
| Question | Answer |
|---|---|
| Major Medical | Type of insurance that does not covered primary care, but covers cost associated with significant illness or injury, such as hospitalization or surgeries |
| Managed Care | Organization that provides comphrehensive health care services for plan participants at a fixed rate |
| Medicaid | Provides health coverage for the categorically needy, a federal health cost assistance program |
| National Provider Identification | Unique 10 digit number assigned to providers to identify them on a CMS 1500 claim form |
| Pre-authorization/Prior authorization | Process of obtaining approval for a service through the the individual's insurance company by establishing that it is medically neccessary |
| Precertification | Process of determind whether a service is covered under the insured person's plan |
| Predetermination | Process of ascertaing the amount the insurance carrier will pay for a specific service |
| Preexisitng condition | A diagnosed and treated health condition that the patinet had before obtaining insurance |
| Preferred Provider Organization (PPO) | a plan allowing the insured person to select physicians, hospitals, and other health care services from an approved list issued by their insurance plan to proivde care at a discounted rate |
| Premium | A dollar amount the insured person pays for insurance coverage |
| Prevailing fee | The usual,customary, and reasonable fees of like providers in the same geographic area |
| Primary Care Provider (PCP) | Physician contracted through a specific insurance plan to provide or to coordinate the care of all patients assigned through the insurance carrier |
| Third Party Provider | The entity(insurance) that pays the second(provider) for the medical bills of the first party (patient, insured or patient) also known as the third party administrator |
| TRICARE | Formerly known as CHAMPUS; health care benefits plans provided by the federal government, primarily for spouses and dependents of service men and women |
| Worker's Compensation | Medical and diability insurance to cover employees in the event of a work-related injury, illness, or death. |
Created by:
d.holifield
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